Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011
Technology (NTNU), Trondheim, Norway; 3HUNT Research Centre, Norwegian University of Science and Technology (NTNU), Levanger, Norway
Background: Anxiety is common among people with obstructive lung diseases. However, reduced lung function in combination with anxiety in relation to the reporting of dyspnoea is not well studied. Objectives: To study the association between reduced lung function and dyspnoea, and how anxiety affects this association. Methods: We analysed data on 5627 women and 5066 men who participated in the Lung substudy of the Nord-Trøndelag Health Study in 1995-97. In a cross- sectional design we used logistic regression to calculate multivariably adjusted odds ratios (ORs) for dyspnoea associated with levels of FEV1% predicted and anxiety (measured by the Hospital Anxiety and Depression scale). Results: Among women with FEV1 ≥100% predicted, those who had anxiety had an OR (95% confidence interval) for reporting dyspnoea when walking of 2.00 (0.68-5.90) compared to those without anxiety. Using the same reference group (FEV1 ≥100% predicted and no anxiety), women with FEV1 80-99% predicted had an OR of 2.46 (1.26-4.83) without anxiety and 7.67 (3.66-16.08) with anxiety, whereas those with FEV1 50-79% predicted had an OR of 4.61 (2.49-8.52) with- out anxiety and 14.37 (6.50-31.78) with anxiety. The corresponding ORs among men without and with anxiety were 1.00 (reference) and 4.55 (0.87-23.70); 1.15 (0.46-2.88) and 5.00 (1.82-13.73); and 4.10 (1.49-11.29) and 14.03 (4.04-48.76), respectively. The ORs for reporting dyspnoea at rest and waking up by dyspnoea showed similar patterns in both women and men. Conclusions: Reduced lung function in combination with anxiety had a stronger association with dyspnoea than reduced lung function alone.
P4113 Functional health status and satisfaction with health in a population reporting a participation or activity limitation: Focus on COPD Donna Goodridge1, Joshua A. Lawson2, Darcy Marciniuk3, Donna C. Rennie2, Koroush Madani3. 1College of Nursing, 2Canadian Centre for Health and Safety in Agriculture, College of Medicine, 3College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
Background: Symptoms associated with COPD can result in participation and activity limitations as well as reduced quality of life. 421. Respiratory epidemiology: quality of life, Objective: To examine the impact of COPD on functional health status (FHS) and satisfaction with health (SWH) in persons with a participation or activity limitation therapy and socioeconomics among a national sample of Canadians. Methods: This survey used data from the 2006 Participation and Activity Lim- itation Survey (PALS), a complex population survey of Canadians reporting a disability on the census. COPD was present if there was a self-report of COPD, P4111 emphysema, or bronchitis as the cause of disability. FHS was assessed using Late-breaking abstract: Postmenopausal hormone replacement therapy is the Health Utility Index (HUI-3) and categorized as high, moderate, or severe. associated with increased risk of asthma hospitalization SWH was categorized as high, moderate, or low. Analyses were weighted to the Klaus Bønnelykk1, Ole Raaschou-Nielsen2, Hans Bisgaard1, Anne Tjønneland2, population and bootstrapping used to estimate variances. Kim Overvad3,4, Zorana J. Andersen2. 1Danish Pediatric Asthma Centre, Results: The sample represents 5,185,980 adults with participation or activity Copenhagen University Hospital, Gentofte, Democratic Peoples Republic of limitation. Subjects without missing data (55%) for the variables of interest were Korea; 2Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, included. COPD was reported as the reason for disability in 1.4% of the popu- Denmark; 3School of Public Health, Aarhus University, Aarhus, Denmark; lation. Among those reporting COPD, 44% reported moderate and 49% reported 4Centre for Cardiovascular Research, Aalborg Hospital, Aalborg University, low SWH. FHS was moderately impaired for 31% and severely impaired for 46%. Aalborg, Denmark After adjustment, COPD was significantly associated with a lower SWH (p<0.05), but not with FHS (p=0.12). Background: Postmenopausal hormone replacement therapy (HRT) has been Conclusions: While FHS was similar to the overall population with a disability, associated with asthma, but is not yet an established risk factor. persons with COPD had a markedly lower SWH, suggesting the need to focus on Aim: To investigate, for the first time, the association between HRT use and risk quality of life enhancement strategies. of severe asthma exacerbations requiring hospitalization in a prospective study. COPD was analyzed simultaneously to account for potential misclassification. Methods: Intake of HRT and potential confounders, including smoking status, P4114 occupational exposure, educational level, body mass index, and hysterectomy, were Lung function decline predicts disability in valued life activities, which in assessed in 1993-1997 in 23 138 postmenopausal women from the Danish Diet, turn predicts impaired quality of life in COPD Cancer and Health cohort. Incident (first-ever) asthma and COPD hospitalizations Paul D. Blanc 1, Jonathan Singer1, Theodore A. Omachi1, Gabriella Sanchez2, were registered prospectively in Danish Hospital Discharge Register between 1993 Carlos Iribarren2 , Miriam Cisternas3, Patricia P. Katz1. 1Medicine, University of and 2006. Association with HRT was analyzed with Cox’s regression analyses. California San Francisco, San Francisco, CA, United States; 2Kaiser Division of Results: We observed 446 (1.9%) incident asthma hospitalizations in 23 138 Research, Kaiser Permanente, Oakland, CA, United States; 3MGC Data Services, women over 9.9 years mean follow-up. 11 575 (50.0%) women ever used HRT. MGC Data Services, Carlsbad, CA, United States Ever using HRT was positively associated with asthma hospitalization (hazard ratio [95% confidence interval]: 1.37 [1.14-1.65]). The risk was highest with the longest Background: Interrelationships among lung function, disability, and health-related duration of HRT use (≥ 10 years: 1.51 [1.15-1.98], 3-10 years: 1.34 [1.05-1.72], < quality of life (HRQL) in COPD need clearer delineation. 3years: 1.29 [1.00-1.67], reference never users). Effect modification was detected Methods: We carried out baseline/follow-up interviews, spirometry, and 6 minute by smoking, indicating strongest effect in never smokers (1.84 [1.32-2.56]) and no walk tests (6MWT) for 646 participants in a COPD cohort (42% male; age 59±6; effect in current smokers (1.08 [0.79-1.45]). HRT was also associated with COPD median follow-up 2.1 years). Valued Life Activities (VLA) disability was scored hospitalization, with a smaller effect (1.19 [1.05-1.35]). with a validated instrument; VLA increased disability [VLA-ID]=0.5 standard Conclusion: HRT use may cause asthma onset or worsening with severe exacer- deviation increase in score baseline-follow-up (14.6% disability). We assessed bation. respiratory-specific HRQL with the Airways Questionnaire 20-Revised. Logistic regression (including age, sex, height) estimated risk by change in absolute values of FEV1 and 6MWT for VLA-ID; linear regression (including the same covariates, P4112 VLA-ID, and baseline HRQL) predicted follow-up HRQL. Lung function and anxiety in association with dyspnoea – The HUNT study Results: Mean decline in FEV1=-91 ml; mean decline in 6MWT=-37 M. VLA-ID 1 2 1 1 Linda Leivseth , Tom Ivar Lund Nilsen ,Xiao-MeiMai , Roar Johnsen , predicted worsened HRQL (p<0.001). Although FEV1 decline predicted VLA-ID 3 1 Arnulf Langhammer . Department of Public Health and General Practice, (p<0.001), neither change in FEV1 or 6MWT was associated with change in Norwegian University of Science and Technology (NTNU), Trondheim, Norway; HRQL. Including FEV1 and 6MWT in multivariate modeling, VLA-ID retained 2Department of Human Movement Science, Norwegian University of Science and its relationship with HRQL (1.3 point change; effect size=0.29; p<0.001).
752s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011
Conclusion: VLA-ID, but not FEV1 or 6MWT decrements, predicted HRQL P4117 impairment. Although FEV1 decline was associated with VLA-ID, worsening The restrictive spirometric pattern is associated with impaired health-related respiratory status did not directly account for HRQL changes. quality of life Clinical Relevance: Interventions directly focused on attenuating disability are Stefano Guerra1, Anne-Elie Carsin1, Jan-Paul Zock1, Benedicte Leynaert2, likely to be critical in preserving HRQL, independent of respiratory function or Christer Janson3, Deborah Jarvis4,JosepM.Anto1. 1Centre for Research in exercise capacity. Environmental Epidemiology, CREAL, Barcelona, Spain; 2INSERM, U700, Support: NIH HL077618, FAMRI CoE2007. Faculté Paris Diderot, Paris VII, Paris, France; 3Department of Medical Sciences: Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden; 4National Heart and Lung Institute, Imperial College, London, United Kingdom P4115 Recreational activity limitation in subjects with and without COPD in five Previous population-based studies have shown that a restrictive spirometric pattern Latin American cities: The PLATINO study is present in a significant proportion of the adult population and is associated M. Montes de Oca1,C.Talamo1,D.Moreno1, A. Menezes2, R. Perez-Padilla3, with an increased risk in morbidity and mortality. However, whether and to M. Lopez4,A.Muiño4,J.Jardim5,G.Valdivia6,J.Pertuze6,R.Halbert7. what extent this pattern is associated with impaired quality of life remains to 1Facultad de Medicina, Universidad Central de Venezuela, Caracas, Venezuela; be determined. In this study, we used data from 6005 participants from eleven 2Faculdade de Medicina, UFPEL, Pelotas, Brazil; 3Pulmonary, INER, Mexico European countries and the US who completed lung function tests and the Short City, Mexico; 4Facultad de Medicina, Universidad de la República, Montevideo, Form-36 (SF-36) questionnaire during the second ECRHS survey. We defined Uruguay; 5Medical School, UNIFESP, São Paulo, Brazil; 6Facultad de Medicina, the restrictive spirometric pattern as FVC < 80% predicted plus FEV1/FVC ≥ PUC, Santiago, Chile; 7School of Public Health, UCLA, Los Angeles, United 70% and the obstructive spirometric pattern as FEV1/FVC < 70%. Physical and States mental component summaries (PCS and MCS) for health-related quality of life were computed and scores transformed so that the mean was 50 and the SD 10. COPD is a progressive and debilitating disease. With worsening disease, patients Mean age of participants was 43 years (range 28 - 56 years) and 51% of them were will progressively become less physically active, will have reduced social contacts, females. Overall, 5254 subjects (87.5%) had a normal, 415 (6.9%) a restrictive and this will create a downward vicious circle. Although much attention has and 336 (5.6%) an obstructive spirometric pattern. The mean PCS was 50.4, 46.9 focused on physical activity limitation, recreational and social activities limitation and 47.6 for subjects with normal, restrictive and obstructive spirometric patterns, are also important to assess the burden of the disease. respectively (p < 0.001). The corresponding MCS mean scores were 50.0, 50.1 We examined the frequency of recreational activity limitation due to health and 49.7 (NS). After adjustment for sex, age, body mass index and smoking, the and lung problem in a population-based study. We used post-bronchodilator restrictive spirometric pattern was associated with a -2.7 PCS deficit (p < 0.001) FEV1/FVC<0.70 to define COPD. Information regarding recreation limitation and the obstructive pattern with a -2.2 deficit (p < 0.001), as compared with the was assessed by the questions: “In the last 12-months, could you not perform normal spirometric pattern. In conclusion, the restrictive spirometric pattern is recreational activities due to your health problems?” and “In the last 12-months, associated with significantly impaired health-related quality of life for how many days in total could you not perform recreational activities due to health or lung problems? Interviews were completed in 5,571 subjects and spirometry was performed in P4118 5,314 subjects. There were 759 COPD and 4,554 individuals without COPD. Dyspnoea in COPD patients recorded in a primary care database Among subjects with COPD 81 (10.7%) reported recreation limitation due to Hana Mullerova1,ChaoLu1, Maggie Tabberer2. 1Worldwide Epidemiology, health problem, compared with 404 (8.9%) of non-COPD subjects (p<0.09). The Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom; number of days with recreational activities limitation due to health problem was 2Global Health Outcomes, GlaxoSmithKline R&D, Uxbridge, United Kingdom increased in COPD in comparison with non-COPD (171.7±18.5 vs. 99.6±7.41 days; p<0.001). Similar findings were observed in the limitation due to lung Background: Dyspnoea is a primary clinical feature of COPD [1,2]. Information problem (45.4±12.3 vs. 11.3±2.63 days; p<0.01). on dyspnoea recording in electronic medical record databases has not yet been These results indicate that COPD is associated important limitation of recreational reported. activities. Understanding the impact of COPD on participation into these activities Methods: A cohort was identified in the UK General Practice Research Database is important for appreciating the overall burden of the disease. (GPRD) (01/01/2003 – 30/6/2010) with both a COPD medical diagnosis code and spirometry (FEV1/FVC <70%) and 12months history before and after cohort entry. OXMIS/Read codes were used to identify and define records of dyspnoea P4116 as probable or possible (less likely associated with COPD) from cohort entry until ECME: Epidemiologic study of the characteristics of women with COPD in censoring. Spain Results: A cohort of 9502 patients was identified: mean age 67 y. (SD 11), Sagrario Mayoralas1, Salvador Diaz Lobato2, Esther Anton3, Xavier Ribera4, 55% males, GOLD stage I: 12%, II: 50%, III: 29%, and IV: 7%. At least one Irune Unzueta3. 1Pneumology Service, Hospital Moncloa, Madrid, Spain; “probable” dyspnoea code was found in 76% of COPD patients; “possible” codes 2Pneumology Service, Hospital Ramón y Cajal, Madrid, Spain; 3Medical were identified in 2% of patients. Codes most frequently associated with dyspnoea Department, Pfizer, Madrid, Spain; 4Medical Department, Boehringer Ingelheim, were “shortness of breath” (16% of patients) and MRC Dyspnoea Scale grade; Barcelona, Spain 45% patients recorded as grade 2, 34% grade 3 and 5.5% grade 4 (frequencies based on the total cohort). Dyspnoea was more often reported by older patients and Background: Chronic obstructive pulmonary disease (COPD) clinical trial popu- those with more advanced disease (69% patients in GOLD stage I with “probable” lations are often predominantly male (∼75%), thus the female population is not dyspnoea vs. 81% in GOLD stages II or IV). so well characterized. Conclusions: Dyspnoea was reported in > 75% of COPD patients identified in the Aims and objectives: Determine a clinical and sociodemographic profile of women GPRD. The high frequency of dyspnoea across all GOLD stages highlights this with COPD in Spain. symptom as a significant burden and possible unmet need in COPD treatment. MRC Methods: Multicenter, cross-sectional, observational epidemiological study. 379 Dyspnoea grade is the predominant code used, linked to the Quality Outcomes pulmonologists from health centers in Spain recruited female patients aged Framework, an NHS system supporting management of selected diseases. ≥40 yrs, smoking history ≥10 pk-yrs, current COPD diagnosis and receiving References: treatment/follow-up during pulmonologist visits. Clinical and sociodemographic [1] Bestall JC, Paul EA, Garrod R et al. Thorax 1999;54:581–6. data were collected during study visit. Descriptive statistics were performed. [2] GOLD: Pocket Guide, December 2010. Results: 1732 women evaluated, of which: 80.8% pulmonologist diagnosis; 46.6% Funded by GSK. primary, 30.8% secondary education; 60.1% current-, 39.9% ex-smokers; 25.5% and 43.1% with history of depression or anxiety, respectively; 78.3%, 65.3%, 63.1% receiving long-acting anticholinergic, long-acting β2-agonist/corticoid, short-acting P4119 β2-agonists. Mean±SD values: age, 61.6±10.0 yrs; body mass index, 26.7±5.1 Symptoms experienced by COPD patients during exacerbations and their kg/m2; time since, and age at, diagnosis, 7.5±6.4 yrs and 54.1±9.8 yrs; pre- association with healthcare utilization – EXACO study and post-bronchodilator FEV1/FVC, 57.5±12.3% and 57.8±12.2%; O2 satura- Isabelle Tillie Leblond, Frédéric Masure, Bruno Housset, Nicolas Roche, tion, 93.8±3.3%; PYI, 35.7±19.9; SF-12 PCS and MCS scores, 37.6±10.5 and Thierry Perez, Isabelle Boucot, François Denis, Aida Myftiu, Juliette Ostinelli, 45.7±12.0; LCADL total, personal care, and household, physical, leisure activities, Isabelle Pithois-Merli, Céline Pribil, Stephane Schück. Pneunology, CHRU 27.2±10.9, 6.5±2.9, 11.8±5.9, 4.5±1.6, 4.4±1.8. Median no. exacerbations in Calmette, Lille, France Pneunology, Groupe Médical Saint Rémi, Reims, France prior year, 1.0 (P25/P75: 0.0/2.0) Pneunology, CHU, Créteil, France Pneunology, Hôtel-Dieu, Paris, France Conclusions: Most women in this cross-sectional study were at an age that they Pneunology, CHRU Calmette, Lille, France Scientific Department, could be actively working. The average FEV1 and exacerbation history suggest an GlaxoSmithKline, Marly Le Roi, France Medical Department, Boehringer impact of the disease on these patients’ daily lives. Ingelheim, Paris, France Medical Department, Nycomed, Paris, France Medical Funded by Boehringer Ingelheim/Pfizer. Department, AstraZeneca, Rueil Malmaison, France Medical Department, Pfizer, Paris, France Epidemiology Department, GlaxoSmithKline, Marly Le Roi, France Scientific, Kappa Santé, Paris, France
Background: Definitions of COPD exacerbations are symptom-based while sever- ity assessment often relies on the level of healthcare utilization.
753s Abstract printing supported by . Visit Chiesi at Stand D.30 Thematic Poster Session Hall 2-29 - 12:50-14:40 TUESDAY,SEPTEMBER 27TH 2011
Objectives: To assess symptoms associated with COPD exacerbations and their ing asthma were invited. MSA was defined from the questionnaire as reporting association with patients’ decision to seek healthcare. physician-diagnosed asthma and reporting use of asthma medication, attacks of Methods: Patients with GOLD stage ≥ II COPD participating in an observational shortness of breath and recurrent wheeze and at least one additional respiratory study, reported symptoms and healthcare use associated with exacerbations by symptom. Asthmatic subjects not having MSA are referred to as “other asthmatics”. telephone interviews. Results: 92% of MSA used asthma medication at the time of the clinical exam- Results: 835 patients reported 3 527 exacerbations. The most common symptom ination, compared with 61% among “other asthmatics”. 71% were on treatment was increased breathlessness. 82.2% of led to a medical consultation, visit to a with steroids and 47% used long-acting β2-agonists (either combined with ICS or hospital. Fever was the symptom most strongly associated with the decision to separately) vs. 40% and 23%, respectively, for “other asthmatics”. Oral steroids seek healthcare. were used by 14% and bronchodilators by nebuliser by 6%, 18% used one or both of these. Frequency of symptoms reported during worsenings of respiratory state and association with Conclusion: Subjects with MSA are to a large extent treated with steroids. We seeking health care conclude that a large majority of multi-symptom asthmatics defined by using Symptom OR (95% CI) for a questionnaire have a more severe disease and only a minority does not use present seeking health care* maintenance treatment. N% Onset of sputum production 1500 42,5 1.2 (0.9–1.6) P4122 Increased sputum production 1159 32,9 0.8 (0.6–1.1) Correlates of high levels of use of short-acting beta agonists in asthma Sputum newly purulent (or more purulent than usual) 1343 38,1 2.0 (1.5–2.6) Laurent Laforest1, Jennifer Martin1, Idlir Licaj1, Gilles Devouassoux2, Onset of head cold 1408 39,9 1.1 (0.9–1.5) Gérard Chatte3, Mélanie Broquet1,EricVanGanse1. 1Unité de Increased breathlessness 2835 80,4 – Pharmacoépidémiologie, Université Claude-Bernard Lyon1, CHU Onset of cough 1547 43,9 1.6 (1.2–2.1) Lyon-Université Claude-Bernard Lyon1, Lyon, France; 2Respiratory Medicine, Increased cough 937 26,6 1.9 (1.4–2.6) Lyon Sud University Hospital, Pierre Benite, France; 3Respiratory Physician, Onset of fever 791 22,4 3.4 (2.2–5.0) Respiratory Physician, Caluire, France Onset of chest pain 810 23,0 1.1 (0.8–1.6) Onset of wheezing 1538 43,6 1.6 (1.2–2.1) Background: High use of short-acting beta agonists (SABAs) may reflect potential Borg score (increase of 1 point) – – 1.2 (1.2–1.3) risks in asthma management. A better understanding of the characteristics of high *Adjusted on age, sex, education level, COPD GOLD stage, chronic bronchitis profile, season of users of SABAs is critical to improve quality of care. exacerbation, and presence of cardiovascular comorbidities. Objectives: To describe asthma patients with high levels of use of SABA, including their characteristics and medical resource utilisation. Conclusions: Breathlessness was by far the dominant symptom of exacerbations Methods: A random sample of patients aged 16-40, with regular use of dis- while fever was the strongest predictor of health care utilization. pensed respiratory drugs (R03, ATC classification) in 2005 was selected from the French claims database (EGB). Asthma-related hospital admissions were retrieved. Patterns of use of SABAs in 2007 were described. The correlates (baseline char- P4120 acteristics and asthma-related variables) of using ≥ 12 SABA units in 2007 were Medication and preventive measures for COPD in the BOLD study identified. Louisa Gnatiuc1, Bernet Kato1, Sonia Coton1, Sonia Buist2, Peter Burney1. Results: Among 2093 patients (median age = 33 year-old, 54% females), 65% 1Respiratory Epidemiology and Public Health, Imperial College London, were using SABAs in 2007 and 8% used ≥ 12 units during this period. These London, United Kingdom; 2Pulmonary & Critical Care Medicine, Oregon Health patients were more likely to have a long-term disease status (p<0.001), free-access- & Science University, Portland, United States to-care status (p<0.01), to use higher levels of systemic corticosteroids (p<0.001), and antibiotics (p<0.001) than other patients. Higher numbers of medical visits Background: Inhaled beclomethasone and salbutamol are three to five times as (p<0.001) and asthma-related hospital admissions (p<0.01) were also observed expensive in poorest settings resulting in poor access (Ait-Khaled N, Rev Mal in this group. Conversely, no noticeable difference appeared with age, nor with Respir 2006, 23, 10S76-10S79). We used the BOLD data to describe differences gender. in reported medication use for COPD. Conclusions: Many patients are still using high levels of SABAs and are possibly Methods: Preventive measures for COPD (flu vaccine in last year, advice or at risk of exacerbations. The reasons of this high use of rescue medication require medication ever to stop smoking) and use of respiratory medications in the last a better understanding. year among population-based samples of adults aged 40+ with spirometrically defined COPD, were assessed across 18 BOLD sites. Results: Over 14,300 subjects had information on flu vaccine and medication use. P4123 Over 7,900 had information on smoking cessation. Prevention strategies and med- Ratio “inhaled corticosteroids to total anti-asthma drugs”, and ication use were significantly more common in the High Income Countries (HIC) asthma-related hospital admissions and in people with COPD than in Low and Middle Income Countries (LMIC) and Laurent Laforest1, Jennifer Martin1, Idlir Licaj1, Gilles Devouassoux2, those with normal spirometry (p<0.000). Differences across countries were not Gerard Chatte3,EricVanGanse1. 1Unité de Pharmacoépidémiologie, 11 rue related to COPD prevalence. Guillaume Paradin, Lyon University Hospital, Claude-Bernard Lyon1 University, Bronchodilators and inhaled corticosteroids use increased with age, severity of Lyon, France; 2Respiratory Medicine, Lyon Sud University Hospital, Lyon, COPD, BMI, any comorbidity or respiratory symptom and it was higher among France; 3Respiratory Physician, Respiratory Physician, Caluire, France the unemployed (p<0.000). After stratifying by country economic level, the use of these medicines was independent of education level and higher among the Background: The inadequate use of inhaled corticosteroids (ICS) remains an unemployed in HICs (p<0.000). The use of medication was not related to pack- issue in asthma. The ratio of ICS units to total anti-asthma medications dispensed years of smoking. However, after stratifying by gender the use bronchodilators and (ICS/R03 ratio) may be useful to assess the risk of severe exacerbations, leading inhaled corticosteroids was significantly higher in women smoking 20+ pack-years to asthma-related hospitalisations (ARHs). We tested this hypothesis using claims (p=0.04). data. Conclusion: The use of COPD prevention and medication is significantly higher Objectives: To verify in claims databases whether patients with a higher ICS/R03 in HICs than in LMICs. Improving access to care in LMICs is important, as is ratio experience fewer ARHs. understanding risk factors for low medication uptake. Methods: A random sample of patients aged 16-40, with regular use of respiratory drugs in 2005 was selected from the French national claims database (EGB). Three groups were defined according to the value of ICS/R03 ratio in 2007: 0% (“non P4121 users”), <50% (“non users”) and ≥50% (“non users”). ARHs in 2007 and 2008 Medication use in multi-symptom asthma: Results from the West Sweden were compared between the 3 groups. asthma study Results: Among 1812 patients (mean age=32 year-old, 54.2% females), non users, Linda Ekerljung, Jan Lötvall, Bo Lundbäck. Department of Internal inadequate users and adequate users, were 17%, 37% and 46%, respectively. ARH Medicine/Krefting Research Centre, University of Gothenburg, Gothenburg, rate was 0.9% in 2007 (0.7% in 2008). Patients with ARH in 2007 were more Sweden numerous (p=0.0006) among inadequate users (2.10%), compared with adequate
users (0.24%) and non users (0.32%). Differences were also observed in mean